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Gupta RR, Mishra AV, Pollmann AS, Betsch DM, Gensure RH, Bailey ST. Diagnostic and Therapeutic Challenges. Retina 2024; 44:364-368. [PMID: 38252488 DOI: 10.1097/iae.0000000000003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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2
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Foveal photoreceptor disruption in ocular diseases: An optical coherence tomography-based differential diagnosis. Surv Ophthalmol 2023:S0039-6257(23)00046-2. [PMID: 36934831 DOI: 10.1016/j.survophthal.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
Fovea centralis, located at the center of the macula, is packed with cone photoreceptors and is responsible for central visual acuity. Isolated foveal photoreceptor disruption may occur in a variety of hereditary, degenerative, traumatic, and toxic chorioretinal diseases. These have been known previously by multiple synonyms including macular microhole, foveal spot, and outer foveal microdefects. A common clinical feature underlying these conditions is the presence of apparently normal fovea or subtle hypopigmented lesion at the foveal or juxtafoveal area. A detailed history along with high-resolution optical coherence tomography is often helpful to derive a conclusive diagnosis in majority of these cases. Focal photoreceptor disruption usually involves loss or rarefaction of ellipsoid/interdigitation zone, either in isolation or associated with external limiting membrane or retinal pigment epithelium disruption in the fovea. Vitreomacular interface (VMI) disorders including vitreomacular traction, posterior vitreous detachment, epiretinal membrane, and impending macular hole possibly remain the most common cause. Retinal dystrophies such as cone dystrophy, occult macular dystrophy, and achromatopsia may present with diminution of vision and normal appearing fundus in a younger age group. Other causes include photic retinopathy (e.g., from a history of sun gazing, or laser pointer exposure), blunt trauma, drug exposure (e.g., poppers maculopathy or tamoxifen retinopathy), and acute retinal pigment epitheliopathy (ARPE). Visual prognosis depends on the underlying etiology with complete recovery common in the subset of patients with VMI, and ARPE, whereas persistent outer retinal defects are the rule in other conditions. We discuss the differential diagnoses that lead to isolated foveal photoreceptor defects. Identifying and understanding the underlying disease processes that cause foveal photoreceptor disruption may help predict visual prognosis.
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3
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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Venkatesh R, Sharief S, Mangla R, Gupta A, Yadav NK, Chhablani J. Selective rod outer segment disruption in commotio retinae — a finding identified on Multicolour® Imaging. Graefes Arch Clin Exp Ophthalmol 2022; 260:3817-3824. [DOI: 10.1007/s00417-022-05758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
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Burke M, Lieu P, Abrams G, Boss J. MACULAR CHOROIDAL THICKNESS IN UNILATERAL COMMOTIO RETINAE. Retin Cases Brief Rep 2021; 15:417-420. [PMID: 30063577 DOI: 10.1097/icb.0000000000000802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To investigate the choroidal thickness (CT) and choroidal area (CA) in patients with unilateral commotio retinae of the macula using spectral domain optical coherence tomography with enhanced-depth imaging. METHODS This is a retrospective review of 16 eyes of 8 consecutive patients with unilateral macular commotio retinae within 7 days of blunt ocular trauma that underwent optical coherence tomography with enhanced-depth imaging seen at our institution. The contralateral, nontraumatized eye served as the control group. All patients underwent spectral domain optical coherence tomography imaging with enhanced-depth imaging protocol. Using the electronic caliper within the Zeiss optical coherence tomography review software, CT was measured from the outer portion of the retinal pigment epithelium band to the inner surface of the sclera. The central horizontal and vertical rasters were averaged to calculate the final CT measurement of each eye. The final CA reading of each eye was obtained by averaging the central 1,500 μm2 of subfoveal CA using the same rasters. The researchers compared the CT, CA, and best-corrected visual acuity in traumatized eyes with macular commotio with their fellow nontraumatized control eyes. RESULTS Traumatized eyes with macular commotio retinae had greater subfoveal CT and CA (P = 0.0027, P = 0.0279) compared with the normal fellow eye. An increase in CT and CA in the subfoveal area in the presence of commotio retinae was associated with worse visual acuity (P = 0.0180). CONCLUSION Subfoveal CT and CA were greater in eyes with commotio retinae when compared with normal fellow eyes. Increased CT and CA in macular commotio retinae were associated with decreased visual acuity.
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Affiliation(s)
- Marie Burke
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Philip Lieu
- W. K. Kellogg Eye Center, Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan; and
| | - Gary Abrams
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Joseph Boss
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
- Cleveland Clinic Foundation, Cole Eye Institute, Department of Ophthalmology, Cleveland, Ohio
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6
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Bennedjai A, Adam R, Akesbi J, Rodallec T, Vidal R, Gaillard R, Nordmann JP. Bilateral Traumatic Maculopathy after Closed-Globe Injury in Context of National Lockdown: A Case Report. Case Rep Ophthalmol 2021; 12:159-163. [PMID: 33976675 PMCID: PMC8077660 DOI: 10.1159/000510381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
The aim of this study is to report a case of bilateral traumatic maculopathy in a 19-year-old male following blunt trauma during 2020 coronavirus disease-2019 national lockdown. Descriptive case report based on data from clinical records, patient observation, and analysis of diagnostic tests. A previously healthy, 19-year-old male presented for a visit in our department at 15-20 National Ophthalmology Institute with complaints of bilateral decreased visual acuity. A history of recent blunt trauma caused by resistance band was reported. Fundus examination recorded fibrosis and inferior preretinal hemorrhages on both eyes. Peripheral retinal examination was normal. Optical coherence tomography showed bilateral increased reflectivity, disruption of the inner/outer segment, and loss of the external limiting membrane. The 6-week follow-up did not show a major recovery. Early detection of posterior segment damage after blunt trauma remains primordial despite worldwide pandemic.
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Affiliation(s)
- Amin Bennedjai
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, Paris, France
| | - Raphaël Adam
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, Paris, France
| | - Jad Akesbi
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, Paris, France
| | - Thibaut Rodallec
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, Paris, France
| | | | - Romain Gaillard
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, Paris, France
| | - Jean-Philippe Nordmann
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, Paris, France
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7
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Venkatesh R, Pereira A, Sangai S, Yadav NK. Hyporeflective micro-elevations and irregularity of the ellipsoid layer: novel optical coherence tomography features in commotio retinae. Can J Ophthalmol 2020; 55:492-499. [DOI: 10.1016/j.jcjo.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/14/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
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Drača N, Cerovski B, Lazić R, Kovačević D, Gabrić K, Gabrić I. Enlarged Foveal Avascular Zone after Whiplash Injury-Acquired Berlin’s Edema. Case Rep Ophthalmol 2020; 11:395-401. [PMID: 32999667 PMCID: PMC7506200 DOI: 10.1159/000509264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022] Open
Abstract
We describe a case of optical coherence tomography angiography (OCTA) changes in the foveal avascular zone (FAZ) in a patient that had suffered Berlin’s edema after a whiplash neck injury. The patient reported central scotoma throughout the 1-year follow-up, confirmed by visual field examination. OCTA showed FAZ enlargement of the left eye as compared to the healthy right eye in the superficial capillary layer and even more in the deep capillary layer. To the best of our knowledge, FAZ enlargement has not been previously described by OCTA after whiplash-related macular injury.
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Affiliation(s)
- Nataša Drača
- Department of Retina, University Eye Hospital Svjetlost, Zagreb, Croatia
- *Nataša Drača, Department of Retina, University Eye Hospital Svjetlost, Heinzelova 39, HR–10000 Zagreb (Croatia),
| | - Branimir Cerovski
- Department of Ophthalmology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ratimir Lazić
- Department of Retina, University Eye Hospital Svjetlost, Zagreb, Croatia
| | - Damir Kovačević
- Department of Ophthalmology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Krešimir Gabrić
- Department of Retina, University Eye Hospital Svjetlost, Zagreb, Croatia
| | - Ivan Gabrić
- Department of Retina, University Eye Hospital Svjetlost, Zagreb, Croatia
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9
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Reduced photoreceptor outer segment layer thickness in mild commotio retinae without ellipsoid zone disruption. Graefes Arch Clin Exp Ophthalmol 2020; 258:1437-1442. [PMID: 32314032 DOI: 10.1007/s00417-020-04678-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/28/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To quantitatively investigate the reflectivity and structure of the outer retinal layers on spectral-domain optical coherence tomography (SD-OCT) in commotio retinae. METHODS Nineteen patients with acute macular commotio retinae and 19 age-matched normal controls were examined using SD-OCT. Longitudinal reflectance profiles (LRP) were obtained using Image J. The reflectivity of outer retinal layers was measured at the fovea, 1 mm nasal to fovea and 1 mm temporal to fovea. The reflectivity ratios of outer retinal layers divided by the outer nuclear layer (ONL) were calculated for normalization. Photoreceptor outer segment layer thickness was also measured. The results were compared between the patients and controls. RESULTS The reflectivity ratio of ellipsoid zone/ONL and outer segment/ONL was higher in commotio retinae than in controls only at fovea (12.66 ± 4.73 vs 9.67 ± 3.34, p = 0.041; 7.70 ± 2.20 vs 3.73 ± 1.63, p < 0.001, respectively) but not at 1 mm nasal or temporal to the fovea. Photoreceptor outer segment layer thickness was significantly shorter in commotio retinae compared to controls at all three locations (19.64 ± 3.05 vs 25.16 ± 3.53, 16.95 ± 4.02 vs 20.00 ± 3.00, and 15.42 ± 3.22 vs 20.05 ± 2.48, respectively, all p < 0.05). CONCLUSIONS Quantitative measurement of SD-OCT images revealed that shortening of photoreceptor outer segment is an additional, and potentially better, biomarker for commotio retinae on top of increased reflectivity.
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Fedirko P, Babenko T, Kolosynska O, Dorichevska R, Garkava N, Grek L, Vasylenko V, Masiuk S. MORPHOMETRIC PARAMETERS OF RETINAL MACULAR ZONE IN RECONVALESCENTS OF ACUTE RADIATION SICKNESS (IN REMOTE PERIOD). PROBLEMY RADIAT︠S︡IĬNOÏ MEDYT︠S︡YNY TA RADIOBIOLOHIÏ 2019; 23:481-489. [PMID: 30582865 DOI: 10.33145/2304-8336-2018-23-481-489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE evaluate the retinal morphometric parameters of the reconvalescents in remote period after acute radi-ation sickness. MATERIALS AND METHODS A complete ophthalmologic examination was carried out on 7 reconvalescents of acuteradiation sickness. The examined are divided into two subgroups: 1) patients with macular degeneration of the reti-na (8 eyes); 2) patients without clinical signs of macular pathology (6 eyes). Parameters of the retina in the cen-tral retina zone studied using the method of optical coherence tomography. To evaluate the results of surveys usedstatistical methods: average values of quantitative indicators calculation, estimation of probability difference byStudent's method. RESULTS Optical coherence tomography revealed a statistically significant increase of the thickness of the retina inthe fovea in all reconvalescents of acute radiation sickness. CONCLUSIONS It was shown that the thickness of the retina in the fovea and paramacular zone in persons who suf-fered acute radiation sickness is significantly higher than in the control. These changes observed in all reconvalis-cents ARS - both in person with sings of macular degeneration, and in those whose clinical manifestations were notdetected. The presence of a correlation between the volume of the retina in the macular zone and the documentedradiation dose of the study group emphasizes the perspectives of next OCT examination of the retina of reconvales-cents of ARS to study the mechanism of retina's damage in this category of victims of the Chornobyl accident.
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Affiliation(s)
- P Fedirko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Melnykova str., Kyiv, 04050, Ukraine
| | - T Babenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Melnykova str., Kyiv, 04050, Ukraine
| | - O Kolosynska
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Melnykova str., Kyiv, 04050, Ukraine
| | - R Dorichevska
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Melnykova str., Kyiv, 04050, Ukraine
| | - N Garkava
- State Institution «Dnipropetrovsk Medical Academy of the Ministry of health of Ukraine», Vernadsky str, 9, Dnipro, 49044, Ukraine
| | - L Grek
- Kyiv City Clinical Ophthalmological Hospital «Eye Microsurgery Center», st. Komarova 3, Kyiv, Ukraine
| | - V Vasylenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Melnykova str., Kyiv, 04050, Ukraine
| | - S Masiuk
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Melnykova str., Kyiv, 04050, Ukraine
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11
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Blegen HMJ, Santamaria JA, Mehta A, Reed DS, Drayna PM, Davies B. Patterns and prognosis of commotio retinae in orbital wall fractures. Ther Adv Ophthalmol 2019; 11:2515841419862133. [PMID: 31321382 PMCID: PMC6628538 DOI: 10.1177/2515841419862133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: Orbital wall fractures are a significant cause of ocular injury in trauma and
are associated with posterior segment pathology. This study aims to
characterize patterns and prognosis of commotio retinae following orbital
wall fracture. Methods: This study is a retrospective analysis of 294 orbital wall fractures
diagnosed by computed tomography imaging from August 2015 to October 2016 at
a Level 1 trauma center. Dilated funduscopic exams were assessed for acute
posterior segment pathology, focusing specifically on commotio retinae
(N = 38). These were compared with patients with no
traumatic retinal findings (N = 253) to indicate
statistically significant differences in the mechanism of injury, fracture
pattern, subjective symptoms, radiologic and exam findings, and acute
interventions. Results: Commotio was most commonly associated with assault (60.5%,
p = 0.004) in a younger patient population, whereas normal
retinal exams were more likely after falls from standing (24.1%,
p = 0.022). Half of all commotio was found inferiorly
and most commonly occurred in medial or inferior wall fracture. Patients
with commotio were more likely to have motility deficits (29.7%,
p = 0.049) with clinical evidence of entrapment (13.2%,
p < 0.001), requiring acute operative repair (15.8%,
p = 0.005). Inferior wall fracture was associated with
19.4% surgical intervention in commotio as compared with those with normal
funduscopic exams (6.1%, p = 0.012). All patients with
follow-up had resolution of commotio and best-corrected visual acuity of
20/25 or better. Conclusion: Retinal pathology is not infrequent in orbital wall fractures. Inferior wall
fracture was associated with 19.4% surgical intervention in commotio as
compared to those with normal funduscopic exams (6.1%,
p = 0.012). A high index of suspicion and thorough
investigation is warranted in evaluating these patients.
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Affiliation(s)
- Halward M J Blegen
- Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX 78215, USA
| | | | - Aditya Mehta
- Brooke Army Medical Center, San Antonio, TX, USA
| | | | | | - Brett Davies
- Brooke Army Medical Center, San Antonio, TX, USA
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12
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Erickson BP, Feng PW, Ko MJ, Modi YS, Johnson TE. Gun-related eye injuries: A primer. Surv Ophthalmol 2019; 65:67-78. [PMID: 31229522 DOI: 10.1016/j.survophthal.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 02/03/2023]
Abstract
Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.
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Affiliation(s)
- Benjamin P Erickson
- Stanford Health Care, Byers Eye Institute at Stanford, Palo Alto, California, USA.
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marcus J Ko
- Nevada Centre for Eye Plastic Surgery, Reno, Nevada, USA
| | - Yasha S Modi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Thomas E Johnson
- Oculofacial Plastic Surgery, Bascom Palmer Eye Institute, Miami, Florida, USA
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13
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Wangsathaporn K, Tsui I. Commotio Retinae Resulting From Rubber Band Injury in Two Girls. Ophthalmic Surg Lasers Imaging Retina 2019; 50:309-313. [DOI: 10.3928/23258160-20190503-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 06/04/2018] [Indexed: 11/20/2022]
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14
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Mansour AM, Shields CL. Microvascular Capillary Plexus Findings of Commotio Retinae on Optical Coherence Tomography Angiography. Case Rep Ophthalmol 2018; 9:473-478. [PMID: 30631274 PMCID: PMC6323412 DOI: 10.1159/000494916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/28/2018] [Indexed: 11/19/2022] Open
Abstract
Optical coherence tomography (OCT) and histopathology features of commotio retinae (CR) have been established, but alterations of the microvascular macular capillary plexus on OCT angiography (OCTA) has not been previously studied. We present a 46-year-old man who sustained a tennis ball injury to the right eye with visual acuity reduction to 20/30 and grey-white deep macular discoloration, suggestive of CR. Spectral-domain OCT (SD-OCT) showed increased reflectivity and thickness of the ellipsoid zone (junction of photoreceptor inner and outer segments). OCTA revealed no apparent microvascular alterations (right versus left eye) in the foveal avascular zone superficial (0.42 vs. 0.43 mm2) and deep (0.45 vs. 0.44 mm2), superficial foveal capillary density (34.1 vs. 32.6%), and superficial parafoveal capillary density (55.2 vs. 52.2%). Deep macular capillary plexus and choriocapillaris were qualitatively comparable between the two eyes. At 2 months' follow-up, SD-OCT had normalized. CR is characterized by disruption of the ellipsoid zone without detectable alteration of the capillary plexuses.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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15
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Braza ME, Young J, Hammeke TA, Robison SE, Han DP, Warren CC, Carroll J, Stepien KE. Assessing photoreceptor structure in patients with traumatic head injury. BMJ Open Ophthalmol 2018; 3:e000104. [PMID: 30539149 PMCID: PMC6257382 DOI: 10.1136/bmjophth-2017-000104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/29/2018] [Accepted: 10/11/2018] [Indexed: 11/17/2022] Open
Abstract
Objective Previous work using adaptive optics scanning light ophthalmoscopy (AOSLO) imaging has shown photoreceptor disruption to be a common finding in head and ocular trauma patients. Here an expanded trauma population was examined using a novel imaging technique, split-detector AOSLO, to assess remnant cone structure in areas with significant disruption on confocal AOSLO imaging and to follow photoreceptor changes longitudinally. Methods and Analysis Eight eyes from seven subjects with head and/or ocular trauma underwent imaging with spectral domain optical coherence tomography, confocal AOSLO and split-detector AOSLO to assess foveal and parafoveal photoreceptor structure. Results Confocal AOSLO imaging revealed hyporeflective foveal regions in two of eight eyes. Split-detector imaging within the hyporeflective confocal areas showed both remnant and absent inner-segment structure. Both of these eyes were imaged longitudinally and showed variation of the photoreceptor mosaic over time. Four other eyes demonstrated subclinical regions of abnormal waveguiding photoreceptors on multimodal AOSLO imagery but were otherwise normal. Two eyes demonstrated normal foveal cone packing without disruption. Conclusion Multimodal imaging can detect subtle photoreceptor abnormalities not necessarily detected by conventional clinical imaging. The addition of split-detector AOSLO revealed the variable condition of inner segments within confocal photoreceptor disruption, confirming the usefulness of dual-modality AOSLO imaging in assessing photoreceptor structure and integrity. Longitudinal imaging demonstrated the dynamic nature of the photoreceptor mosaic after trauma. Multimodal imaging with dual-modality AOSLO improves understanding of visual symptoms and photoreceptor structure changes in patients with head and ocular trauma.
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Affiliation(s)
- Matthew E Braza
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathon Young
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas A Hammeke
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Scott E Robison
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dennis P Han
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Clinton C Warren
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kimberly E Stepien
- Department of Ophthalmology and Visual Sciences, University of WI - Madison, Madison, Wisconsin, USA
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16
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Cham KM, Di pasquale DN, Jaworski A. A case of commotio retinae following champagne cork injury. Clin Exp Optom 2018; 101:140-142. [DOI: 10.1111/cxo.12515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/10/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kwang Meng Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia,
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17
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Ahn SJ, Woo SJ, Park KH, Lee BR. Retinal Pigment Epithelium Sequelae Caused by Blunt Ocular Trauma: Incidence, Visual Outcome, and Associated Factors. Sci Rep 2017; 7:14184. [PMID: 29079856 PMCID: PMC5660211 DOI: 10.1038/s41598-017-14659-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/13/2017] [Indexed: 11/22/2022] Open
Abstract
Vision loss can occur in eyes with blunt ocular trauma, but the causes have not been elucidated fully. We encountered cases of retinal pigment epithelium (RPE) sequelae following blunt ocular trauma associated with permanent vision loss in our cohort of patients with blunt ocular trauma. In this multicentre retrospective cohort study on 129 patients with retinal abnormalities caused by acute blunt ocular trauma, we investigated the incidence of RPE sequelae and evaluated associated factors and visual outcomes. RPE sequelae, which typically presented as hyperpigmentation within well-demarcated hypopigmented lesions, occurred in 29 (22.5%) patients within 1 month of trauma. Optical coherence tomography (OCT) revealed complete photoreceptor loss over the abnormal RPE. Final visual outcomes were significantly different between eyes with and without RPE sequelae. Logistic regression analysis revealed a significant association between the presence of subretinal fluid and RPE sequelae. In conclusion, RPE sequelae occurred in approximately 20% of patients with blunt ocular trauma and was associated with permanent photoreceptor defects and visual loss. Clinical evaluation using OCT may help predict RPE sequelae and visual outcomes in eyes with blunt trauma.
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Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Seoul, South Korea. .,Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam, South Korea.
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung Ro Lee
- Department of Ophthalmology, Hanyang University Hospital, Seoul, South Korea.
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Ishikawa Y, Hashimoto Y, Saito W, Ando R, Ishida S. Blood flow velocity and thickness of the choroid in a patient with chorioretinopathy associated with ocular blunt trauma. BMC Ophthalmol 2017; 17:86. [PMID: 28595625 PMCID: PMC5465595 DOI: 10.1186/s12886-017-0480-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Choroidal circulation hemodynamics in eyes with ocular blunt trauma has not been quantitatively examined yet. We quantitatively examined changes in choroidal blood flow velocity and thickness at the lesion site using laser speckle flowgraphy (LSFG) and enhanced depth imaging optical coherence tomography (EDI-OCT) in a patient with chorioretinopathy associated with ocular blunt trauma. CASE PRESENTATION A 13-year-old boy developed a chorioretinal lesion with pigmentation extending from the optic disc to the superotemporal side in the right eye after ocular blunt trauma. The patient's best-corrected visual acuity (BCVA) was 0.2 in the right eye. Indocyanine green angiography showed hypofluorescence from the initial phase, with a decrease of mean blur rate (MBR) on LSFG color map, which corresponded to the chorioretinal lesion. The BCVA and foveal outer retinal morphologic abnormality spontaneously improved during follow-up. MBR and choroidal thickness increased by 23-31% and 13-17 μm at the lesion site and by 11-22% and 33-42 μm at the fovea, respectively, during the 6-month follow-up period after baseline measurements in the affected eye. In contrast, these parameters showed little or no changes at the normal retinal site in the affected eye and the fovea in the fellow eye. CONCLUSIONS Current data revealed that both blood flow velocity and thickness in the choroid at the lesion site decreased in the acute stage and subsequently increased together with improvements in visual function and outer retinal morphology. These results suggest that LSFG and EDI-OCT may be useful indices that can noninvasively evaluate activity of choroidal involvement in ocular blunt trauma-associated chorioretinopathy.
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Affiliation(s)
- Yuri Ishikawa
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuki Hashimoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan. .,Kaimeido Eye and Dental Clinic, Sapporo, Japan.
| | - Ryo Ando
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
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SUBRETINAL FIBROSIS AFTER ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN EYES WITH MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2017; 36:2140-2149. [PMID: 27124880 DOI: 10.1097/iae.0000000000001043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the incidence and risk factors of subretinal fibrosis and their impact on visual outcome in eyes with myopic CNV. METHODS Medical records of 72 eyes treated with antivascular endothelial growth factor (anti-VEGF) therapy in a pro re nata regimen for myopic CNV that followed up for more than 1 year were retrospectively reviewed. The presence of subretinal fibrosis after anti-VEGF therapy was determined using both fundus photographs and optical coherence tomography. The incidence and risk factors of subretinal fibrosis were evaluated, and best-corrected visual acuity was compared between the eyes with and without subretinal fibrosis. RESULTS The incidences of subretinal fibrosis during the 1-year and whole follow-up period were 31.9% and 36.1%, respectively. Occurrence of subretinal fibrosis was associated with frequent CNV recurrence (P = 0.005) and poor baseline best-corrected visual acuity (P = 0.044) in a Cox proportional hazard model. Anatomically, the eyes with subretinal fibrosis showed more frequent progression of chorioretinal atrophy (95.7% vs. 71.4%, P = 0.027) and less frequent photoreceptor recovery (17.4% vs. 65.3%, P < 0.001) after anti-VEGF therapy. Occurrence of subretinal fibrosis was associated with poor vision at baseline (P = 0.011) and the final visit (P = 0.008) when compared with the findings in the nonoccurrence group. CONCLUSION Development of subretinal fibrosis after anti-VEGF therapy was common in eyes with myopic CNV and was associated with CNV recurrence. Myopic eyes with subretinal fibrosis show progressive chorioretinal atrophy and poor visual outcome.
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Atalay K, Kirgiz A, Kaldirim HE, Mert M, Guliyev DA, Cabuk KS, Taskapili M. Severe blunt eye trauma causes a decrease in central macular thickness within first 48 hours of trauma. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0905.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Blunt eye trauma is an important emergency in ophthalmology practice, and may alter the structure of the macula.
Objectives
To evaluate the optic coherence tomography (OCT) measurements of central macular thickness (CMT) among patients admitted to the hospital within 48 hours of blunt eye trauma.
Methods
Prospective cross-sectional study to evaluate patients who were admitted to hospital with blunt eye trauma within 48 hours trauma. Spectral domain OCT was used to measure macular thickness. CMT measurements of 24 healthy and 26 traumatized eyes of same patients were analyzed as control and case groups, respectively.
Results
The mean CMT measurements were 230.04 ± 18.64 μm in control and 226.50 ± 18.89 μm in traumatized groups. The difference between two groups was not statistically significant (P = 0.412). However, when the patients were classified according to the severity of trauma, CMT measurements of severely injured patients were found significantly lower than both healthy and mildly traumatized eyes (P = 0.008, P = 0.004, respectively).
Conclusions
Early stage macular OCT findings at blunt eye trauma may change with the severity of trauma. We have determined an insignificant increase in the mildly traumatized group in CMT compared with the healthy group within the first 48 hours of blunt trauma as a sign of macular trauma. However, in the severely traumatized group in CMT values significantly decreased, which may be a sign of cellular loss. Further prospective studies with long follow-up periods are warranted to elucidate the effects of this decrease in thickness.
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Affiliation(s)
- Kursat Atalay
- Bagcilar Education and Research Hospital, Eye Clinic , Istanbul 34200 , Turkey
| | - Ahmet Kirgiz
- Bagcilar Education and Research Hospital, Eye Clinic , Istanbul 34200 , Turkey
| | | | - Metin Mert
- Bagcilar Education and Research Hospital, Eye Clinic , Istanbul 34200 , Turkey
| | - Derya Alp Guliyev
- Department of Ophthalmology , Sakarya ToyotaSA Emergency Aid Hospital, Sakarya 54580 , Turkey
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Hashimoto R, Hirota A, Maeno T. Choroidal blood flow impairment demonstrated using laser speckle flowgraphy in a case of commotio retinae. Am J Ophthalmol Case Rep 2016; 4:30-34. [PMID: 29503919 PMCID: PMC5757451 DOI: 10.1016/j.ajoc.2016.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose To report the time course of choroidal blood flow (CBF) in a commotio retinae case using laser speckle flowgraphy (LSFG). Observations A 58-year-old Japanese man with complaints of worsening left visual acuity after blunt eye trauma was diagnosed with commotio retinae. A funduscopic examination showed macular opacity, and LSFG results demonstrated CBF impairment in the affected eye. Optical coherence tomography also showed disruption of the photoreceptor outer segment. Seven months after the initial visit, CBF was significantly increased, along with improvement in the photoreceptor outer segment. Conclusion and importance: We revealed CBF impairment in a case of commotio retinae for the first time. CBF impairment may be involved in the pathogenesis of commotio retinae, and LSFG may be useful for examining CBF in commotio retinae.
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Affiliation(s)
- Ryuya Hashimoto
- Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, 285-8741, Japan
| | - Asato Hirota
- Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, 285-8741, Japan
| | - Takatoshi Maeno
- Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, 285-8741, Japan
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MACULAR MICROSTRUCTURAL FEATURES IN CHILDREN WITH TILTED DISK SYNDROME EVALUATED BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY. Retina 2016; 37:305-315. [PMID: 27404961 DOI: 10.1097/iae.0000000000001140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess macular microstructure in eyes with tilted disk syndrome (TDS) and determine the relationship between TDS foveal morphology and visual function. METHODS Twenty-six TDS eyes from 19 children (aged 5∼15 years) with a spherical equivalent refraction (SER) of -3.1 ± 1.3 diopter (D) and 28 control eyes from 14 children (aged 7∼12 years) with a SER of -3.0 ± 0.7 D were recruited. Horizontal and vertical optical coherence tomography scans through the fovea produced images that were segmented into eight intraretinal layers. Thicknesses of the total retina and each layer were measured at the foveal center and 12 other macular locations: 500 μm, 1,000 μm, and 1,500 μm along the horizontal and vertical meridians. The relationships between TDS best correct visual acuity (BCVA) and the presence of photoreceptor inner/outer segment (IS/OS) junction line, IS/OS foveal bulge, and cone outer segment tip (COST) line were evaluated. RESULTS The thickness of TDS central fovea, 218.94 ± 22.20 μm, was not significantly different from controls. The total retinal thickness in TDS eyes was thinner than controls at all peripheral locations (P < 0.05) except at 500 μm and 1,000 μm superiorly, and 1,500 μm temporally. Tilted disk syndrome intraretinal layer thicknesses in the nasal and inferior regions varied significantly from controls (P < 0.05). Only 80.7% and 23.1% of TDS eyes had a normal foveal bulge and continuous COST line, respectively, compared with 100% and 96.4% of controls. The BCVA of TDS eyes was similar whether or not the foveal bulge or COST line was abnormal. CONCLUSION Differences in intraretinal layer thickness may be correlated with defective vision.
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Abstract
PURPOSE To evaluate outer retinal structural abnormalities in patients with visual deficits after closed-globe blunt ocular trauma. METHODS Nine subjects with visual complaints after closed-globe blunt ocular trauma were examined between 1 month after trauma and 6 years after trauma. Spectral domain optical coherence tomography was used to assess the outer retinal architecture, whereas adaptive optics scanning light ophthalmoscopy was used to analyze the photoreceptor mosaic integrity. RESULTS Visual deficits ranged from central scotomas to decreased visual acuity. Spectral domain optical coherence tomography defects included focal foveal photoreceptor lesions, variable attenuation of the interdigitation zone, and mottling of the outer segment band, with one subject having normal outer retinal structure. Adaptive optics scanning light ophthalmoscopy revealed disruption of the photoreceptor mosaic in all subjects, variably manifesting as foveal focal discontinuities, perifoveal hyporeflective cones, and paracentral regions of selective cone loss. CONCLUSION We observe persistent outer retinal disruption in subjects with visual complaints after closed-globe blunt ocular trauma, albeit to a variable degree. Adaptive optics scanning light ophthalmoscopy imaging allows the assessment of photoreceptor structure at a level of detail not resolvable using spectral domain optical coherence tomography or other current clinical imaging tools. Multimodal imaging seems to be useful in revealing the cause of visual complaints in patients after closed-globe blunt ocular trauma. Future studies are needed to better understand how photoreceptor structure changes longitudinally in response to various traumas.
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Mendes S, Campos A, Beselga D, Campos J, Neves A. Traumatic maculopathy 6 months after injury: a clinical case report. Case Rep Ophthalmol 2014; 5:78-82. [PMID: 24707277 PMCID: PMC3975199 DOI: 10.1159/000360692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This study aims to report a case of traumatic maculopathy in a 12-year-old male following blunt trauma in his left eye (LE) who presented 6 months after injury. METHODS Retrospective and descriptive case report based on data from clinical records, patient observation and analysis of diagnostic tests. RESULTS A previously healthy, 12-year-old male presented for a routine visit with complaints of a 2-month history of decreased visual acuity in his LE. Six months before the initial visit, he suffered blunt trauma to the LE during a struggle and had no medical observation. At the visit, best-corrected visual acuity (BCVA) in the LE was counting fingers and in the right eye, it was 20/20. Fundus examination of the LE showed a central macular lesion of 1 disc diameter with fibrosis, increased retinal thickness and intraretinal hemorrhage. Optical coherence tomography showed disruption of the inner/outer segment (IS/OS) photoreceptor junction, increased reflectivity, cell infiltration of the retinal wall and retinal pigment epithelium detachment. Retinal thickness was 289 μm at the site of the lesion. A fluorescein angiogram revealed early impregnation and late diffusion. High-dose steroid pulse therapy (intravenous methylprednisolone 500 mg for 3 days and oral prednisolone 30 mg, tapering for 10 days) was done. LE BCVA increased to 20/200, and retinal thickness decreased by 71 μm 1 week after treatment. Off-label intravitreal triamcinolone (IVTA; 0.05 ml/2 mg) was administered 2 weeks after oral treatment in an attempt to achieve additional improvement. Three weeks after IVTA, LE BCVA improved to 20/150 and retinal thickness decreased by 10 μm. Three months after the initial visit, LE BCVA was 20/125 and retinal thickness 208 μm. CONCLUSION We present a case of commotio retinae caused by an ocular blunt trauma 6 months before, with loss of BCVA. BCVA improved after oral steroids and IVTA. Nevertheless, fibrosis and disruption of the IS/OS junction in the macula limited the gain of BCVA.
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Affiliation(s)
- Sílvia Mendes
- João Paulo Castro Sousa Ophthalmology Department, Leiria Hospital Center, Leiria, Portugal
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